Individual
MICHAEL R MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3111 GUNDERSON DRIVE, ONALASKA, WI 54650-8512
(608) 796-8630
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1178
WI
363AS0400X
Surgical Physician Assistant
9485
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42989500
—
WI
Enumeration date
06/10/2005
Last updated
07/30/2015
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